Inter-observer and Intra-observer Agreement in Pathological Evaluation of Non-alcoholic Fatty Liver Disease Suspected Liver Biopsies (original) (raw)
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Non-alcoholic Fatty Liver Disease Diagnosis, Grading and Staging; A Simplified Tool for Clinicians
Non-alcoholic Fatty Liver Disease (NAFLD) is currently reliably and increasingly being diagnosed and classified by non-invasive methods in comparison with standard invasive methods. Various permutations and combinations has been studied and explored with different clinical sign and symptoms with or without lab profiles to closely approach the precise diagnosis. It is indeed the need of the hour to understand the most suitable non-invasive clinical modality in a given set of patient profile to reach to the finest and closest diagnosis without compromising the outcome as far as the patient management is concerned. This could well be learnt progressively to more and more effectively use of these non-invasive tools and avoiding cumbersome liver biopsy in parallel Fatty liver is frequently used terminology in the day to day reporting of routine and focused abdominal imaging. This leaves a good amount of stress and alarm on patients and their kin's mind. The most frequently asked question after these reports is 'what is the current status and what next ?' Various clinical methods extending from a single parameter to combination of various clinical laboratory profile has been tried to answer the question precisely. There are a lot of scores and system which exists in the literature but 'which one to use and where to use' is sporadically arranged making it difficult in usability. This is to simplify the same and make better understanding of the topic for the clinicians to objectively answer all the queries related to stage, grade and diagnose of this entity. Furthermore it is attempted to reliably use the non-invasive modalities of staging and grading to replace cumbersome liver biopsy without compromising the clinical benefits out of management dependent on these parameters. CONVENTIONAL METHODS NAFLD should strongly be suspected in patients with deranged liver enzymes and/or who have features of metabolic syndrome. However, before labelling a person as NAFLD extensive/detail history (alcohol abuse, drug intake) must be taken and serological studies (viral and autoimmune hepatitis, alpha-1-antitrypsin deficiency, hemochromatosis and Wilson's disease) should be done.
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Archives of Iranian medicine, 2010
Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is important to have a uniform and validated method for scoring liver histology in these patients. Therefore, we propose a modification of the Brunt system by scoring the four histologic features separately and reporting their sums as the nonalcoholic steatohepatitis activity index. A nonalcoholic steatohepatitis activity index was defined which scored the grade of disease activity between 0 and 12 according to four histologic features: steatosis, hepatocyte ballooning, portal inflammation, and lobular inflammation. Fibrosis was separately scored between 0 and 4. A total of 60 liver specimens collected from nonalcoholic steatohepatitis patients were scored by two pathologists at the time of biopsy and after three months. Liver enzyme levels were also correlated with the histologic score. The intra-rater agreement (weighted kappa) for various variables of the scoring system was between 0.59 and 0.80 for one p...
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The evolving role of liver biopsy in non-alcoholic fatty liver disease
Annals of Hepatology, 2018
Evaluation patients with nonalcoholic steatohepatitis (NASH) imply the need of appropriate assessment of disease severity (i.e. the presence of nonalcoholic steatohepatitis (NASH)) as well as of the disease stage (i.e. the extent of liver fibrosis). Liver biopsy (LB) is still considered the gold standard for diagnosing NASH as well as for establishing the degree of liver fibrosis. However, due to its invasive nature and costs, use of LB should be restricted to selected patients and, according guidelines and expert opinion, indicated in the following scenarios: a) when LB will guide treatment, b) to confirm or exclude NAFLD in patients with conflicting clinical data, c) to increase patient’s awareness about their disease, and improve engagement in their care and d) for inclusion in clinical trials. However, the role fo LB in NAFLD is evolving since when new and costly therapeutic agents become available, LB will be eventually necessary to make clinical decisions. The use of non-invas...
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